A few years back, insurance companies were apprehensive about selling a medical insurance policy to people with pre-existing conditions. Though things have changed dramatically, people in such situations still face challenges, denials and claim rejections while trying to secure the best health
insurance plan for the family. In order to overcome these, you must act as an informed policy buyer and follow the right steps. Here’s a useful guide to help you.

If Possible, Buy a Medical Insurance Policy Early

Chances of getting diagnosed with an illness or medical condition increase with age. The best time to buy health insurance is when you are in the mid-20s. By doing so, the hurdle of pre-existing conditions might not even be present in the first place. Getting insured early has additional benefits. For example, you would start getting the tax advantage at the beginning of your job itself. Also, the medical insurance policy premium would be lower than what people pay in their 30s, 40s and so on.

Since many people are unaware about the exact meaning of pre-existing conditions, it is important to know what pre-existing diseases are.

What Is Pre-Existing Condition In Health Insurance Policy?

It is a medical condition/disease that existed before you obtained health insurance policy, and it is significant, because the insurance companies do not cover such pre-existing conditions, within 48 months of prior to the 1st policy.  It means, pre-existing conditions can be considered for payment
after completion of 48 months of continuous insurance cover. (Source)

It is worth mentioning that the term ‘pre-existing condition’ also includes:

Medical history related to the illness
History of hospitalization
Signs and symptoms generally associated with an illness
Intake of medications for an illness
Injuries resulting from a major accident etc.

Based on these parameters, you need to evaluate your situation before approaching an insurer for a medical insurance policy. For example, diabetes and hypertension are considered as pre-existing conditions. If you have been taking medications for high blood pressure, your case would again be
counted in this category. However, a heart attack is not a pre-existing condition, though it is believed to be. Though, if you are prone to heart attacks or are undergoing treatment for any heart-related ailment, this would be a case of a pre-existing condition.

Never Hide a Pre-existing Condition

Many people try to hide their pre-existing conditions which may lead to serious consequences. Many insurance companies sell health insurance only after conducting necessary health and medical checkups and tests with the help of a medical expert. There are high chances that your insurer would deny the claims, if it finds from the medical history and records that the condition had existed before the medical insurance policy was purchased.

You should be open to medical tests and diagnosis of pre-existing conditions as it would help you get the best health insurance plan for family. It may also help you win the legal battle in case the insurer unfairly rejects the claims.

Check with Different Insurers

The terms and conditions and other important clauses regarding health insurance for people with pre-existing conditions vary from one insurance company to another. Find out how to make the best out of these provisions:

Premium Loading: Many insurers offer the best health insurance plan for family even to those with pre-existing conditions, but only after demanding an additional premium. For example, a person with high blood pressure in the mid-30s may have to pay a premium higher than the healthy insurance buyers in the same age group. Compare premiums with different companies to choose the best deal.

Waiting Period: In regard to pre-existing condition medical policies, the waiting period is the time for which the insured would have to wait before he or she starts getting the insurance benefits. For example, if you are a heart patient and your insurer decides the waiting period to be 4 years, you will have to pay from your pocket if you undergo any treatment related to the condition for this time period. The policy would start paying only after 4 years. You must check with various health insurers as some of them reduce the waiting period to 2 years.

Portability: If you plan to switch from your current insurer to a new one, make sure that the waiting period term remains intact. For example, Max Bupa insurance company ensures that if a policyholder insured by some other insurer has already served 3 years out of the waiting period of 4 years; the company would allow portability with only 1 year remaining as the waiting period.

Some Useful Tips and Information

i. Renew the Medical Insurance Policy on Time: If you fail to do so, the waiting period may get relapsed and restart from the beginning. Also, on-time renewal might make you eligible for certain benefits as the insurer’s valuable customer.

ii. Group Cover to Individual Policy Benefits: The IRDAI instructs that if an insured had been a beneficiary of a group health plan from his or her employer, he may convert it into an individual retail medical insurance policy at the time of leaving the employment. In such a situation, the individual plan would impose no waiting period.

iii. Diseases Diagnosed During Waiting Period: If the insured is diagnosed with any kind of disease/ailment during the waiting period, it can’t be counted as a pre-existing condition and would be fully covered under the plan.

iv. Option to Co-pay: You may also offer the option to co-pay to your insurer if the later is determined to deny you health insurance due to a pre-existing condition. Co-pay condition implies that a percentage of the claimed amount would be paid by the insured from his or her pocket.

v. Exclusion of the Condition: If nothing works out, you may agree for complete exclusion of the pre-existing condition from the cover. It would at least help you avail cover for any other medical condition and unforeseen expenses in the future.

How an Experienced Insurer Can Help Better?

The topmost insurers like Max Bupa not only promise short waiting periods and wide cover (up to INR 1 crore), but offer other benefits through best health insurance plan for family that covers everyone from newborn to senior citizens. One great aspect of the company is their 30 minute claim settlement procedure. The company doesn’t outsource its claim settlement services to any third party but has its own customer service team trained to offer swift cash settlement at any of its 3,500 network hospitals across India. In addition, the insurer imposes no extra premium loading in return
to the insurance cover renewal for life. You can have a look at their Health Companion Plan that helps save up to 12.5% premium on the second year’s premium on a 2 year policy tenure.

Make efforts in the right direction to compare different insurance plans to get the best health insurance plan for family in the situation of pre-existing conditions. If you are able to obtain a good medical insurance policy with, for example, a waiting period of 2 years, follow the right routine of healthy eating and exercising to prevent/postpone any medical emergency.